Health Insurance Claims

Quick Claim Process Flowchart: Reliance Health Insurance Claim Process

Health insurance is indispensable as it offers much-needed protection against unforeseen medical expenses.

It is like a financial backup that makes quality healthcare accessible without worrying about the hefty costs. During an emergency, you can claim your policy to receive the necessary financial assistance.

At Reliance General Insurance, we offer a smooth and swift health insurance claim process to ensure a satisfactory resolution of your medical claims.

Whether you are filing a cashless claim or looking for reimbursement, our claims experts ensure an effective and timely resolution.

What is Health Insurance Claim Settlement?

Health insurance claim settlement is a process in which your insurance company pays for the medical expenses covered under your health policy.

During a medical emergency, you can either opt for cashless settlement or request reimbursement if you have already paid your bills.

Note that the final settlement takes place after you submit all the necessary documents.

Here is how the Reliance health claim process works

Types of Health Insurance Claims

Cashless Health Insurance Claims

The cashless claim process allows you to receive treatment at a medical facility without making any upfront payments.

Earlier, cashless claim settlement was only available at the insurance company's network hospitals. This means you must get your treatment at the insurer's network hospital if you want a cashless settlement.

However, after the launch of the "Cashless Everywhere" initiative in 2024, cashless treatment is now available at any hospital across India.

The cashless hospitalisation process enables you to focus on your health and get treatment without worrying about the mediclaim reimbursement process.

Reimbursement Health Insurance Claims

The reimbursement medical claims process is based on the traditional settlement approach. In this process, you can get the desired treatment and settle all the bills from your pocket.

Once you have all the medical invoices and bills, you can submit them along with other documents to the insurer to receive compensation.

How to Claim Health Insurance: Step-by-Step Process

Reliance Health Insurance Claim Process

Claim intimation is a process of informing the health insurance company about your upcoming hospitalisation or treatment.

This is the first and critical step in the claims settlement process. Note that any delay in claim intimation can lead to the rejection of your claim.

• For Planned Hospitalisation:

  You must intimate your claim at least 48 hours (two days) before your planned admission date.

  For example, If you are supposed to be admitted to the hospital on 22 September, register your claim before 20 September according to the admission time.

• For Emergencies Hospitalisation: ​

  You must intimate or register your claim immediately or within 24 hours of emergency hospitalisation.​

Details Required for Health Insurance Claim

1. Policy number

2. Name of policyholder

3. Name of insured (in case of family and group health insurance)

4. Nature of illness or accident

5. Name and address of attending doctor

6. Date of emergency or planned admission to the hospital.

7. Any other information requested by our claims department.

Reliance Cashless Health Insurance Claim Process

• Step 1: Register your claim using the steps mentioned above.

• Step 2: Once your claim has been authorised, get cashless treatment at any hospital.

• Step 3: After the treatment, our TPA (Third Party Administrator) at the select hospital will review and settle your hospitalisation expenses.

Reliance Medical Claim Reimbursement Process

• Step 1: Register your claim using the steps mentioned in the above section.

• Step 2: Get the desired treatment at any hospital and settle your bills.

• Step 3: Once you have all the bills and required documents, submit them to our claims department for reimbursement.

For any query/complaint/assistance, reach out to RCare Health (our in-house health claims department).

List of Health Insurance Claim Documents

1. Duly filled and signed health claim form. (Original)

2. Reference letter from the doctor advising hospitalisation.

3. Prescriptions for drugs, diagnostic tests or consultations attested by the doctor.

4. Original pharmacy bills.

5. Original pathology/diagnostic test reports.

6. Ambulance bill

7. Death certificate (if applicable)

8. Post-mortem report (if applicable)

9. FIR (if applicable)

10. Any case-specific medical insurance claim documents requested by our claims department.

Types of Hospitalisations Covered by Reliance Health Insurance Claims

Emergency Hospitalisation

Emergency hospitalisation is when you require immediate medical attention due to sudden illness, accident or injury.

For this, you need to inform the insurance company within 24 hours of admission to the hospital.

Planned Hospitalisation

Planned hospitalisation is when you already know about the medical procedure or treatment you are going to go ahead with. It is usually advisable for specific treatment or pre-planned surgery.

If you plan to be hospitalised, you must inform the insurance company at least 48 hours before the planned date of admission.

Things to Consider While Applying for Health Insurance Claims

Timely Claim Intimation

Timely claim intimation is important for a successful health insurance claim settlement. Hence, register your claim within the specified timelines.

Submit Complete Documents

A successful claims settlement requires accurate documentation. Hence, make sure to submit all the required documents in a correct and authentic form.

Use Correct Claims Form

You may need to use a different claim form depending on the type of insurance plan you have. Make sure to download and submit correct and complete claims forms.

Learn About Exclusions

Before filing your claim request, make sure to check the exclusions of your medical claim insurance policy. This will help you prevent claim rejection for events that are not covered by your policy.

Avoid Duplicate/Fake Claims

Raising fake and duplicate claims can lead to several consequences. These include policy cancellation, legal actions, penalties and whatnot. Hence, raise only genuine claims by providing correct information.

Common Medical Claim Rejection Reasons in India

Also Read: ​5 Reasons Why Your Health Insurance Claims Are Delayed

How to Appeal a Rejected Health Insurance Claim?

Steps to Check Health Insurance Claim Status

• Step 1: Visit our Health Claims

• Step 2: Enter your policy or claim reference number on the top-right of your screen.

• Step 3: Click on "Show My Claim Status & Upload Pending Documents" to view your medical claim status.

Health Insurance Claims: Cashless Vs Reimbursement

Can You Claim Health Insurance from Multiple Insurance Companies?

Yes. If you have multiple health insurance plans from different providers, you can distribute the claim expenses between them. Here is how:

• Claim with the first insurance policy up to the given claim limit.

• Once you have reached the maximum limit with your first policy, you can pass the remaining amount to the next insurer.

• To do this, you need to submit the complete summary of the first settlement to the next insurer. In addition, you also need to share all the original bills and documents with both insurers to keep them informed.

• For health insurance plans that offer a single lump sum payout (for example, critical illness insurance), you can claim up to your full sum insured with each provider.

Important Things to Remember When Filing Claims with Multiple Insurers

• Make sure that all the insurance providers involved in the process are well-informed and aware.

• Avoid making duplicate claims, as they can lead to the termination of your policy.

• Read the specific terms and conditions of your policy before raising the claims.

Also Read: Claiming Multiple Health Insurance Policies

Frequently Asked Questions About Health Insurance Claims

• Why is Reliance the best claim settlement health insurance company?

  Reliance General Insurances is named among the best claim settlement health insurance companies for multiple reasons. These include 100% claims settlement, quick settlement, online claims processing, etc.

• What is the meaning of the health insurance claim settlement ratio?

  The health or medical claim settlement ratio shows an insurer's efficiency in settling claims. It is a ratio of settled claims against the total number of claim requests received by the company.

  The higher the CSR, the greater the chances of a smooth and satisfactory claims settlement. At Reliance General Insurance, we offer a 100% claims settlement ratio to ensure hassle-free financial assistance.

• When is the best time to claim health insurance?

  You can raise a claim anytime after your waiting period is complete. However, it is recommended that you file a claim only when it is necessary.

  By avoiding making claims for minor events, you can gain no-claims bonus discounts. Such rewards can help you save a lot of money when you renew your policy.

• How much can I claim with my health insurance?

  The maximum amount you can claim with your health insurance depends on the nature of the claim policy and the selected sum insured. In most cases, you can claim up to 100% of your selected sum insured.

• How many times can I claim my mediclaim health insurance?

  The number of times you can claim your health insurance is decided based on the type of plan you have. Most health insurance policies allow you to make multiple claims during the tenure.

• Should I opt for a cashless or reimbursement claim settlement?

  Reliance General Insurance has efficient cashless and reimbursement claim procedures. You can choose either at your convenience.

  If you want a quick settlement with minimal out-of-pocket expenses, go with cashless claims settlement. However, if cashless hospitalisation is not practical, you can opt for medical claim reimbursement.

• What do I need to file a reimbursement claim with my health insurance?

  To file reimbursement claims, collect all the original bills and hospitalisation documents.

  Next, fill out a claims form and submit it along with all the specified documents. Once your documents are verified, your claim decision will arrive within 15 days of final submission.

• What if the TPA rejects my cashless treatment request?

  If your pre-authorisation request for cashless hospitalisation is rejected due to some reason, you can proceed with the reimbursement process.

  For this, get your treatment, clear all the bills and then file a reimbursement claim. For more assistance, call our claims helpline.

• What is excluded from health insurance plans?

  The exclusions of health insurance differ based on the policy type. The most common issues that are not covered by most medical insurance policies include self-made injuries, cosmetic treatments, lifestyle-related treatments, etc.

  To learn about complete exclusions of your health insurance policy, check out your policy wordings.

• What is the role of waiting periods in health insurance claims?

  A waiting period means a pre-defined number of days you need to wait before making your first health insurance claim. In simple words, you can not file a claim until your waiting period is complete.

• Can I raise my medical claim online?

  Yes. You can file a claim smoothly through our official website or the Self-i mobile application. From claim intimation to document submission, we offer a quick and smooth digital claim process.

• What should I do if my health insurance claim gets rejected by the company?

  If your health insurance claim gets rejected, learn about the reason behind this rejection.

  In case it is rejected due to incorrect or incomplete documents, you can claim it again by correcting the mistakes.

  However, if you are not satisfied with the reason, you can raise an appeal through our Grievance Redressal system.
  

• I am not satisfied with my claim settlement. What should I do next?

  If you are not satisfied with your claim amount or have any complaints, you can appeal using your grievance redressal procedure.

• Can I claim my health insurance before completing the waiting period?

  No. You must complete the specified waiting period of your policy to be eligible to file a claim. Note that raising a claim before serving the waiting period can lead to its rejection.

• Will my claims be settled if I file a request during the grace period?

  Any claim raised after the expiry of a health insurance policy is likely to be rejected. However, renewing your expired policy during the grace period can help you reinstate it without losing the benefits. These benefits include no-claims bonus discounts, loyalty discounts, etc.